1 Tackling the obesity epidemic in a 15 minute office visit.Kelly Redden, DO Internal Medicine – Greenbrier Clinic Connie Gottshall, MS, RDN, LDN Nutritionist – Greenbrier Clinic

2 The speaker has nothing to disclose in this presentation.Disclosure The speaker has nothing to disclose in this presentation.

3 Goals of the talk Discuss the 5 principles of healthy living and the evidence behind them Provide physicians tools to use when treating obese patients Discuss the concept of “volumetrics” We have no disclosures

4 Dr. Redden’s 5 Principles of Healthy Living (Female)1) Exercise 150 minutes per week. 2) Eat 30 grams of protein with each meal. 3) When eating a sweet or starch, the portion must fit in the palm of your hand. 4) Abstain from ALL sweets and starches after 5pm. 5) Don’t drink sugar.

5 Dr. Redden’s 5 Principles of Healthy Living (Male)1) Exercise 150 minutes per week. 2) Eat 45 grams of protein with each meal. 3) When eating a sweet or starch, the portion must fit in the palm of your hand. 4) Abstain from ALL sweets and starches after 5pm. 5) Don’t drink sugar.

6 Exercise 150 minutes per weekWhy 150? Where did that number come from? Initially from INTERHEART study which looked at patients from 52 different countries and the role exercise had in preventing MI. Many other retrospective studies showed this amount of exercise lowered risk of DEATH by 23%. There have been studies in Men, Women, Kids, Athletes, patients with CVD vs just risk factors, etc. NAVIGATOR trial (over 9000pts with metabolic syndrome) showed that walking alone significantly lowered risk for CVD even if BP, weight and lipids remained the same.

7 Exercise 150 minutes per weekThis value is intended to “maintain health” and usually 300 minutes per week is goal for weight loss. 75 minutes should be weight-lifting or weight-bearing and 75 minutes should be cardiovascular (aerobic). Silver Sneakers Muscle = Fat burned

8 Exercise 150 minutes per weekAnd here come the excuses… I don’t have time I am too exhausted My knees/back/feet wont allow me My fibro makes me hurt too bad I get migraine headaches if I do cardio I don’t have money to join a fitness center and on and on and on…

9 Eat 30/45 grams of protein per mealWow! That seems like a lot. Why??? Medically speaking we need to prevent sarcopenia. In layman’s terms, if you are full on protein you will eat less crap. Protein helps you to build and maintain muscle mass. The more muscle mass you have the more fat you burn even when you are sleeping.

10 Eat 30/45 grams of protein per mealCue the excuses… I am a vegetarian/vegan I have high cholesterol I thought red meat was bad for you I eat my “meat” on a bun They are too expensive I don’t have time to cook I have no idea how many grams of protein are in any food. Can you spend the next 45 minutes explaining that to me???

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12 I wish I had a NUTRITIONIST!!!

13 I am incredibly luck to have one at my practice and you will hear from her in just a few minutes regarding the role of protein in our diets as well at educating patients about the concept of “volumetrics” Eatright.org to find nutritionist. eatright.org

14 eatright.org

15 The correct serving size of a sweet or starch is the palm of your handYou do not need scales or measuring cups. I encourage you to eat sweets and starches so you don’t feel deprived but also because they are a great source of energy. Portion control is key. You are limited to 1 sweet or starch per meal however. If you want sweet potato fries then no bun on your chicken sandwich. If you want gelato after lunch then you need to eat a salad with salmon

16 The correct serving size of a sweet or starch is the palm of your handMost patients do not complain when I tell them to eat a sweet or starch but they do often have several questions about this one. Remember that fruit is a “sugar” so not unlimited. If we keep a food diary we usually find we have many more sweets and starches in a day then we think.

17 Abstain from ALL sweets and starches after 5 pmThis one is hard! Our society teaches that dinner is typically our biggest meal of the day. For many busy families “dinner” comes from a fast food restaurant or the microwave. Bedtime snack is typically a sweet or starch. To most of our patients, sweet and starches mean things like bread, rice, potatoes, cookies, fruit, noodles, candy, pop, etc. If you have a patient that is well educated in dietary nutrition, you will need to clarify that 1 cup of green beans has 7 gm of carbs but green beans are not a “starch”. They are a complex carbohydrate. Simple carbohydrates are what we are trying to avoid.

18 Abstain from ALL sweets and starches after 5 pmThe good news…serving sizes for protein and veggies after 5 pm are VERY LARGE so you will not be hungry. The bad news…alcohol is a either a sweet (wine) or a starch (beer) and therefore not permitted. Put big red line through alcohol.

19 Don’t drink sugar Ever! If you are going to intake sugar I want you to chew it, process it, possibly use it for energy but not mindlessly drink it. Connie will discuss just how much sugar most of our patients are ingesting in their beverages. Sneaky sources…sugar in coffee or tea, fruit juice and smoothies, and alcohol.

20 Take home message Talk to your patients about diet and exercise.Lead by example. Have a hand-out to save time but also make them “think” at home. “Practice” The 5 Principles 5/7 days per week. Make realistic weight loss/dietary goal and actually address them at follow-up visits.

21 Now let’s talk to the EXPERT!Eatright.org to find nutritionist.

22 PRINCIPLES OF “VOLUMETRICS”PEOPLE TEND TO EAT ABOUT THE SAME AMOUNT OF FOOD DAILY TWEAK FAVORITE HIGH CALORIE FAVORITES GO FOR BROTH-BASED SOUPS, VEGETABLES, SALADS, & FRUIT DON’T “DRINK” YOUR CALORIES

23 IF LARGE PORTIONS ARE YOUR CHALLENGE, THIS IS THE BOOK FOR YOU!

24 CONSIDER “CALORIES PER BITE” AND BE “MINDFUL”

25 Switching gears to Protein…

26 MAKE LIFESTYLE CHOICES TO MINIMIZE “SARCOPENIA”NORMAL PROCESS OF HUMAN AGING MULTIPLE CAUSES: changes in muscle fibers, hormonal shifts, blood vessel impairment, pH, inflammation/oxidation

27 DR. DONALD K. LAYMAN TAUGHT NUTRTION 30 UNIV. OF ILLINOIS, URBANA OVER 98 PEER-REVIEWED ARTICLES AREAS OF EXPERTISE: DIABETES, OBESITY, MUSCLE HEALTH & METABOLISM

28 MINIMIZE MUSCLE LOSS THROUGH STRENGTH RESISTANCE TRAINING & DIET:RDA: ADEQUATE VS. OPTIMAL TYPE & TIMING CONSIDERATIONS SOURCES OF PROTEIN “THERMIC EFFECT” OF PROTEIN

29 Questions????